Undernutrition measured by the Mini Nutritional Assessment (MNA) test and related risk factors in older adults under hospital emergency care.

OBJECTIVES: In developed countries, undernutrition affects mostly older adults, worsens with hospitalization, and affects immune response, with higher rates of infection and delayed wound healing-which leads to an increase in hospital stay and health costs. The aim of this study was to assess the prevalence of undernutrition and related risk factors in a sample of older adults who presented at the emergency room (ER) of a university hospital in Spain. METHODS: This was a cross-sectional study of 288 patients ≥70 y of age who were seen at the emergency department at the University Hospital of Valladolid. Variables of nutritional evaluation, including a Mini Nutritional Assessment Test, sociodemographic factors, comorbidities, chronic treatments, frequency of visits to the ER, and destination after hospital discharge were collected. RESULTS: The percentage of undernutrition was 14.9% and the risk for undernutrition was 54.5%. Most patients were able to independently conduct basic activities of daily living (BADLs), lived at home, resided in an urban environment, and had autonomous mobility. The mean body mass index (BMI) was 26.14 ± 4.52 kg/m2. Patients who were dependent on others for BADLs; institutionalized or bedridden; and with hematologic disease, chronic depressive syndrome, polymedication, low hemoglobin or low hematocrit, and hypochromia were associated with a higher prevalence of undernutrition. In the multivariate analysis, for each unit of increase in BMI, patients had 12% lower risk for developing undernutrition, and for each unit of increase in the frequency of ER visits, patients had a 41% higher risk for developing undernutrition. CONCLUSIONS: Older adults who presented to the ER had a high percentage of undernutrition, which is related to sociodemographic factors, comorbidities, polymedication, and biochemical factors. We also found a direct association between the frequency of ER visits and undernutrition, in addition to an inverse relationship with BMI. Detecting undernutrition in an ER may improve health and reduce related complications in older adults.

Parathyroid Hormone Polymorphism RS6254 is Associated with the Development and Severity of Osteoporosis in Asymptomatic but not Normocalcemic Hyperthyroidism.

Although normocalcemic and asymptomatic hyperparathyroidism (HPT) are becoming more common, they remain only partially understood. Parathyroid hormone (PTH) polymorphisms have been associated with disease severity in classical HPT. The aim of the present study was to evaluate the clinical effect of PTH polymorphism (rs6254) in normocalcemic and asymptomatic HPT. A prospective study of 61 consecutive patients with normocalcemic or asymptomatic HPT was carried out. Secondary causes of HPT were ruled out. All patients were followed for≥1 year. Calcium and phosphorus metabolism parameters were assessed at least twice during the follow-up period to classify as normocalcemic or asymptomatic HPT. Bone mineral density (BMD) and the rs6254 polymorphism genotype were also assessed. Genotype rs6254GG was observed in 23 patients (37.7%) whereas GA and AA genotypes were presented in 29 (47.5%) and 9 (14.8%) patients, respectively. Age, sex and genotype distributions were comparable in both groups. In asymptomatic but not normocalcemic HPT patients, the GG genotype was associated with a significantly higher level of intact PTH [200.2 (SD 76.5) vs. 113.3 (SD 25.9) pg/ml; p<0.01], and significantly lower Z-score densitometry at the femoral neck, proximal femur, and lumbar spine. Both remained significant after adjusting for major confounding factors by multiple linear regression. The present study supports the independent pathogenic effect of rs6254GA polymorphism on the development and severity of BMD complications in patients with asymptomatic but not normocalcemic HPT. Further studies are needed to confirm this finding and to assess the effect of other polymorphisms in normocalcemic and asymptomatic HPT.

Clinical and financial implications of disease-related malnutrition in a department of Internal Medicine: prospective cohort study. / Repercusiones clínicas y económicas de la desnutrición relacionada con la enfermedad en un servicio de Medicina Interna: estudio de cohortes prospectivas.

BACKGROUND: Disease-related malnutrition is a challenge for Spanish hospitals. Our objective was to assess the feasibility and importance of establishing a nutritional screening strategy in our community. PATIENTS AND METHODS: A prospective cohort study was conducted in a department of internal medicine for 3 months. The nutritional screening was conducted at admission and was repeated weekly using the Malnutrition Universal Screening Tool. We analysed the clinical data, mean stay and expenses. RESULTS: The study included 330 patients (53.9% men), with a mean age of 77.8 years. The mean stay was 7 days, and the Charlson comorbidity index was 5.4. At admission, the Malnutrition Universal Screening Tool detected 26.9% of patients with a risk of malnutrition. Eighteen percent of the patients with a good nutritional state developed malnutrition during the hospitalisation. The patients with initially severe malnutrition had a longer mean stay. The patients whose nutritional state worsened during the hospitalisation had a significantly longer stay (2.5 days) compared with those whose state did not worsen. These cases of malnutrition caused a cost overrun of €767 per hospitalisation (35% greater), which entailed a malnutrition-related excess expenditure of €646,419.93 annually in the studied department. The appropriate coding resulted in an increase in mean weight from 2.11 to 2.81, which represented €82,568.52 and has not been previously quantified. CONCLUSION: The high prevalence and clinical and financial implications of Disease-related malnutrition in patients hospitalised in internal medicine warrants establishing protocols for its early detection and treatment.

Clinical Expression of Calcium Sensing Receptor Polymorphism (A986S) in Normocalcemic and Asymptomatic Hyperparathyroidism.

Normocalcemic and asymptomatic hyperparathyroidism diagnosis are becoming more common. However, their pathophysiology is incompletely known. The aim of the present study was to evaluate the clinical effect of calcium-sensing receptor polymorphism (A986S) in normocalcemic and asymtomatic HPT. Prospective study conducted with 61 consecutive normocalcemic and asymptomatic HPT patients was followed up during a minimum period of 1 year. Secondary causes of hyperparathyroidism were ruled out. Calcium and phosphorus metabolism parameters were evaluated in at least 2 determinations during follow-up to classify as normocalcemic or asymptomatic hyperparathyroidism. Bone mineral density and A986S polymorphism genotype were also analyzed. Thiry-eight patients (62.3%) had the genotype A986A, and 23 (36.7%) patients had A986S (20 patients, 32.8%) or S986S (3 patients, 4.9%). Age, sex, and genotype distributions were comparable in both normocalcemic and asymptomatic hyperparathyroidism. In normocalcemic patients, S allele genotype was associated to statistically significant higher level of intact PTH: 92.0 (SD 18.5) vs. 110.6 (SD 24.4) pg/ml, p<0.05; and remained significant after adjustment by multiple linear regression. In asymptomatic hyperparathyroidism, A986A genotype resulted in a statistically significant higher level of intact PTH, alkaline phosphatase and procollagen amino-terminal propeptide; but only serum calcium remained as an independent predictor of serum intact PTH levels after a multiple linear regression. Bone mineral densitometry between genotypes did not show statistically significant differences. A986S polymorphism of CaSR is an independent predictor of PTH level in normocalcemic hyperparathyroidism patients, but not in asymptomatic hyperparathyroidism. More studies are needed to evaluate the effect of other polymorphisms in normocalcemic and asymptomatic hyperparathyroidism.

Depression and health related quality of life among HIV-infected people.

BACKGROUND AND OBJECTIVES: Little is known about the impact of comorbid psychiatric symptoms in health related quality of life (HRQL) in patients with HIV infection. The aim of this investigation was to describe depressive symptoms and the impact in HRQL in HIV infected people. MATERIALS AND METHODS: A cross-sectional study over 150 HIV-outpatients in a tertiary hospital was designed. Depression data were obtained using the Beck Depression Inventory, Second Edition (BDI-II) inventory. HRQL data were collected by disease-specific questionnaire MOS-HIV. Researchers' team designed a specific template to get rest of the data. RESULTS: Almost three-quarters of the population were men. After adjusting for gender and age, HIV-related symptoms and presence of depression were found to be negatively associated with all the Medical Outcomes Study HIV Health Survey (MOS-HIV) general domains and in the Physical Health Summary score and Mental Health Summary score. CONCLUSIONS: Optimization of HRQL is particularly important now that HIV is a chronic disease with the prospect of long-term survival. Quality of life and depression should be monitored in follow-up of HIV infected patients. Comorbid psychiatric conditions may serve as markers for impaired functioning and well-being in persons with HIV.

[Nutritional characteristics and lifestyle in university students]. / Características nutricionales y estilo de vida en universitarios.

Obesity and the lifestyle characteristic of our society lead young people to conditions of potential cardiovascular risk. The aim of this study was to assess the anthropometrical situation and the lifestyle in a sample of university students. A full anthropometrical evaluation was undertaken, including bioelectric impedance analysis (BIA), in 111 students in the last year of Human Nutrition and Dietetics, as well as a lifestyle questionnaire (physical activity, alcohol and cigarette consumption). A sexual dimorphism was found in weight distribution according to the classification proposed by SEEDO: 6.4% of women presented a weight lower than the health recommendations (there no men in this group) whereas 27.8% of men and 6.5% of women were in the overweight range. 15.3% of the cases had excessive waist circumference. Fat mass by BIA was higher among women. On the other hand, 67% of university students stated to perform regular physical activity, 16.7% stated being cigarette smokers, and 55.6% stated to consume high-grade alcohol. To conclude, we studied a sample population of young and healthy subjects with, however, a significant percentage of women with body weight lower than the healthy standards, overweighed people, and smokers usually taking high-grade alcohol. These data should elicit an alert of the potential cardiovascular risk in the university population if action is not taken. This population should be included in the health promotion plans.

Estudio de las características antropométricas y nutricionales de los adolescentes del núcleo urbano de Valladolid / Study of the anthropometric and nutritional characteristics of adolescents in the city of Valladolid

Objetivos: Descripción de las características antropométricas de una muestra de adolescentes de Valladolid junto al análisis de ingesta dietética del grupo de población. Material y métodos: Estudio de campo observacional descriptivo transversal, de una muestra de 557 adolescentes (14 - 18 años), seleccionada por muestreo probabilística de entre 6 institutos públicos y privados, de distintos barrios de Valladolid. Se realizó un cuestionario de frecuencia de consumo junto a la medición antropométrica. La clasificación de los individuos se realizó mediante el cálculo del Z-score del Índice de Masa Corporal (IMC),los puntos de corte para el IMC de Cole y criterios de la International Diabetes Federation (IDF). El análisis nutricional se realizó mediante un enfoque probabilístico y el índice de adecuación nutricional. Resultados: El exceso de peso es similar en ambos sexos(17%), sin emabargo existe un 15,2% de prevalencia de bajo peso entre las mujeres estudiadas, frente al 4,5% en varones(p<0,005). El 1,3% presentan riesgo de padecer síndrome metabólico. El consumo energético se distribuye: 30-32% lípidos, 45% hidratos de carbono y 16-17% proteínas. La valoración nutricional refleja probable déficit de consumo en yodo, zinc, vitaminas A y E. Conclusiones: La prevalencia de obesos está próxima ala de otras series, pero la prevalencia de sobrepeso es inferior. Es muy importante el porcentaje de mujeres con IMC por debajo de lo normal para su edad y sexo. Existe un exceso de aporte proteico, de grasas saturadas y de colesterol, con un déficit en el consumo de hidratos de carbono, yodo, zinc y vitaminas A y E (AU)

Objectives: A description of the anthropometric characteristics of a sample of adolescents from Valladolid and the analysis of dietary intake of the population. Materials and methods: Observational study of descriptive cross-field of a sample of 557 adolescents (14 - 18years) by probabilistic sampling from 6 public and private, in different districts of Valladolid. We carried out a food frequency questionnaire with anthropometric measurements. The classification of individuals was by calculating the Z-score of body mass index (BMI), the Cole`s cut off points for BMI and criteria of the International Diabetes Federation (IDF). Nutritional analysis: probabilistic approach and the nutrient adequacyratio. Results: Excess weight is similar in both sexes (17%),but there is a 15.2% prevalence of underweight among the women studied, compared to 4.5% in males (p<0.005). 1.3% risk of having metabolic syndrome. Energy consumption is distributed: 30-32% fat, 45% carbohydrates and 16-17% protein. The nutritional deficiency likely reflects consumption in iodine, zinc, vitamins A and E. Conclusions: The prevalence of obesity is close to that of other series, but the prevalence of overweight is lower. It is very important percentage of women with a BMI below normal for their age and sex. There is an excess of protein intake of saturated fat and cholesterol, with a deficit in the consumption of carbohydrates, iodine, zinc and vitamins A and E (AU)

[Study of the anthropometric and nutritional characteristics of adolescents in the city of Valladolid]. / Estudio de las características antropométricas y nutricionales de los adolescentes del núcleo urbano de Valladolid.

OBJECTIVES: A description of the anthropometric characteristics of a sample of adolescents from Valladolid and the analysis of dietary intake of the population. MATERIALS AND METHODS: Observational study of descriptive cross-field of a sample of 557 adolescents (14-18 years) by probabilistic sampling from 6 public and private, in different districts of Valladolid. We carried out a food frequency questionnaire with anthropometric measurements. The classification of individuals was by calculating the Z-score of body mass index (BMI), the Cole´s cutoff points for BMI and criteria of the International Diabetes Federation (IDF). Nutritional analysis: probabilistic approach and the nutrient adequacy ratio. RESULTS: Excess weight is similar in both sexes (17%), but there is a 15.2% prevalence of underweight among the women studied, compared to 4.5% in males (p<0.005). 1.3% risk of having metabolic syndrome. Energy consumption is distributed: 30-32% fat, 45% carbohydrates and 16-17% protein. The nutritional deficiency likely reflects consumption in iodine, zinc, vitamins A and E. CONCLUSIONS: The prevalence of obesity is close to that of other series, but the prevalence of overweight is lower. It is very important percentage of women with a BMI below normal for their age and sex. There is an excess of protein intake of saturated fat and cholesterol, with a deficit in the consumption of carbohydrates, iodine, zinc and vitamins A and E.

[Vegetarian diets; effect on health]. / Dietas vegetarianas; repercusión sobre la salud.

Vegetarian diets are those diets mainly based on the consumption of vegetable product, but that also permit consumption of eggs and milk. The American Dietetic Association made a declaration on these vegetarian diets in which they stated that <>. Some studies have shown beneficial results in obesity, cancer, Parkinson disease, hypertension, type 2 diabetes mellitus and urinary stones, compared with the omnivorous. The possible theoretical benefits in some diseases has been seen in the medical practice (diabetes mellitus, obesity, cardiovascular risk). However more studies are needed in the case of Parkinson's disease and rheumatoid arthritis.

[National registry of Home Enteral Nutrition in 2003]. / Registro nacional de la Nutrición Enteral Domiciliaria del año 2003.

GOAL: To communicate the information available by the NADYA-SENPE Working Group from patients on Home Enteral Nutrition (HEN) in our country during the year 2003. MATERIAL AND METHODS: The data were collected through a closed questionnaire included in the web site of the Working Group (www.nadya-senpe.com) available only by the authorized users. Variable included were: epidemiological information, the indication to prescribe this treatment, the access path, the specific nutritional formula used, the treatment duration, the complications and hospital readmission related to the nutritional treatment, the follow-up and the quality of life. RESULTS: We register 3,858 patients that belong to twenty-one hospitals. Mean age from those adults 66.2 +/- 18.9 years, and from those younger than 14, 6.0 +/- 4.3 years. Neurological and neoplasic diseases were the diagnostics more frequents (38.9% and 37.4%, respectively). Oral nutrition was the preferential rout used for the enteral nutrition (54.7%) followed by naso-enteral tube (26.6%), and only in 17.6% we used ostomy tubes. Polymeric was the enteral formula mainly utilized (80.1%). The mean time on HEN was 6.6 +/- 4.3 months; the 28.8% of patients stayed in the treatment for less than 3 months, 21.2 % between 3 and 6 months, and 50.0% more than 6 months. Patients were followed mainly by Nutritional Support Unit from the reference hospital (73.1%). While the reference hospital supplies the material (62.4%), reference hospital pharmacy (46.8%) and public pharmacies (32.0%) provides the enteral formula. Complications related to enteral nutrition included change of enteral tube (44.5%), gastrointestinal complications (30.5%), mechanical complications (21.7%), and the metabolic one (3.3%). These complications were followed by 0.02 hospitalizations/patient. At the end of the year, 54.7% of patients were in the HEN programme, and in 35.2 % HEN was finish due to accept oral conventional alimentation (49.2%) or by deceased of patients (40.9%). While 26.6% of the patients were confined to bed or armchair, 19.7 % no or light discapacity degree was observed. CONCLUSIONS: We found a persistence of these treatment in our country. Neurological and neoplasic diseases were the more frequent diagnosis in patients analysed. The high prevalence of cancer patients could be the main cause of oral access for enteral nutrition. Change of enteral tube was the more frequent complication observed during this treatment.

[Maple syrup disease: a rare entity that we must know. Review of its dietetic management]. / Enfermedad de jarabe de arce: una entidad rara que debemos recordar. A propósito de su manejo dietético.

Maple syrup disease is secondary to a deficiency of deshydrogenase complex of a cetoacid of branched-chain. This disease has a recessive autosomic inheritance, with an incidence of 1/200,000 newborns, without differences between male and female. Due to clinical presentation and biochemical response to tiamin, these patients can be classified in five clinical entities: classic, intermediate, intermittent, positive response to tiamin and deficiency of dihydrolipoyl deshydrogenase (E3). In these patients, an increase of seric branched-chain aminoacids is detected, it could be detected by (chromatography) during neonatal period. Valine, isoleucine, and aloisoleucine are increased in serum, orine, and cephaloraquideum liquid by ionic changed chromatography, chromatography of high resolution or high voltage electrophoresis. Patients have two phases in this disease (acute phase and maintaining phase). Objectives in acute phase are based in three topics: to eliminate toxic metabolites, nutritional support and to get anabolism. Utilization of hemodialysis/peritoneal dialysis/blood exchange is one of the first treatments. Dietetic support is the second treatment, with a minimum energy intake and controlling blood levels of aminoacids. Modified dietetic formulas is a main device to treat these patients.

[Mini Nutritional Assessment (MNA) test as a tool of nutritional evaluation in hospitalized patients]. / Mini Nutritional Assessment (MNA) como método de evaluación nutricional en pacientes hospitalizados.

OBJECTIVE: The objective of the study was to identified the prevalence of malnutrition in come patients with MNA (Mini Nutritional Assessment) test as a clinical tool. METHODS: A total of 145 patients were studied in Hospital del Río Hortega (Valladolid), from mars of 2000 till may of 2002. In all patients a MNA test, an anthropometric and biochemical evaluation were performed. RESULTS: Mean age was 57.44 +/- 18.06 years, weight 63.5 +/- 13.7 kg and body mass index 23.4 +/- 4.9 kg/m2. The studied population were 48.6% haematological tumours and other tumours, opposite to the rest of the patients who were presenting cerebro-vascular accidents 2.1%, respiratory problems or infections 16.8%, renal failure 3.5% and neurological diseases or processes of dementia in minor proportion 2.9%. Patients were divided in two groups, malnutrition MNA < 17 (n = 99) (group I) and risk of malnutrition MNA = 17 (n = 43) (group II). The malnutrition prevalence was 68.2% (group I) and risk of malnutrition 29.6% (group II) with test MNA. In biochemical evaluation the malnutrition group I had low levels of albumin (2.9 +/- 0.7 g/dl vs 3.41 +/- 2.71 g/dl; p < 0.05), prealbumin (14.9 +/- 6.2 g/dl vs 17.6 +/- 8.1 g/dl; p < 0.05) and transferrin (152.2 +/- 54.9 g/dl vs 189.9 +/- 32.6 g/dl; p < 0.05. Arm muscular circumference and arm circumference had values under average in patients with malnutrition. On having analyzed the different paragraphs of the test MNA between both groups, it was observed since in the group of undernourished patients the punctuation he was below the average in all the paragraphs. CONCLUSIONS: The risk of malnutrition in hospital was frequent, detected by MNA test.

[Colonic polyps: dysplasia predictive factors]. / Pólipos de colon: factores predictivos de displasia.

OBJECTIVE: Analyze the presence of dysplasia in colonoscopy visualized colonic polyps, and the predictive factors for high grade dysplasia. MATERIAL AND METHODS: We studied the polyps observed in the colonoscopies carried out during the year 2001. Colonoscopies carried out in 2,144 patients were analyzed, with demonstration of polyps in 326 patients (average age: 67 12,6 years, 63,5% males). 732 polyps were analyzed, with average of 2.27 2 polyps by patient. RESULTS: 72% polyps were located distally to splenic flexure, and sigmoid colon was the most frequent location (34.7%). Most of the polyps (86%) were sessile. Only 3% were > 2 cm, and the majority (88%) was < 1 cm. The most prevalent histological type was tubular adenoma (36%). Dysplasia was observed in 42.2% (low grade in 40% and high grade in 2.2%) Size > 1 cm and location proximal to splenic flexure were the only variables with indendent significant association to high grade dysplasia. CONCLUSIONS: The presence of high grade dysplasia in the colonic polyps was related in our cohort both to the location of the polyps in the colon and to its size, so that greater risk was for proximal polyps and for polyps > 1 cm.

Effects of dietary intake and life style on bone density in patients with diabetes mellitus type 2.

OBJECTIVE: The aim of our study was to investigate the relation among glycemic control, lifestyle and dietary intake with bone mineral density in patients with diabetes mellitus type 2. DESIGN: Cross-sectional study. SETTING: Tertiary care hospital. PARTICIPANTS: A cross-sectional study in a tertiary care hospital was performed. Ninety-two patients attending our diabetes service (56 females/36 males) with diabetes mellitus type 2 were enrolled in a consecutive way. The inclusion criteria were diabetes diagnosed >40 years of age, with type 2 diabetes defined in accordance with the criteria of the American Diabetes Association and no use of dietary supplements. Body mass index, waist-to-hip ratio, glucose level, and HbA1c levels were assessed in all patients. X-ray densitometry of the calcaneal region and a 3-days written food record keeping, and a qualitative questionnaire of lifestyle were also performed. RESULTS: A total of 21.7% of patients had osteoporosis (T score <2.5 SD). Patients were overweight with a high BMI and a medium glucose control. Patients with osteoporosis were older than those without osteoporosis (67.8 +/- 6.9 vs. 62.1 +/- 9.2 years; p < 0.05). Significant differences were detected between patients without and with osteoporosis in calcium intake (1,219.37 +/- 387 vs. 839 +/- 251 mg/day; p < 0.05) and zinc intake (9.23 +/- 3.5 vs. 13.3 +/- 6.9 mg/day; p < 0.05), respectively. No differences were detected in other dietary dairy intakes. In correlation analysis age (r = -0.23; p < 0.05) and BMI (r = 0.48; p < 0.05) was correlated with BMD. In univariate analysis with dicotomic variables, only exercise was positive associated with osteoporotic status (87.5% exercise habit in patients without osteoporosis and 25% exercise habit in patients with osteoporosis; p < 0.05). In a logistic model with the dependent variable (osteoporosis), remained in the final model dietary dairy intake of calcium and zinc, BMI, age and exercise. Exercise, calcium intake and BMI were protective factors. Zinc intake, and age were risk factors. CONCLUSIONS: Exercise, calcium intake, body mass index had a protective role in bone mineral density in patients with diabetes mellitus type 2. Zinc intake and age were risk factors in our population.

[Enteral nutrition; direct costs in a tertiary care hospital]. / Nutrición enteral; costes directos en un hospital terciario.

INTRODUCTION: The studies in which the direct costs generated by enteral nutrition have been analyzed in hospitals of our country are limited. The objective of our study has been the analysis of costs incurred by this treatment in our center. MATERIAL AND METHODS: A total of 449 consecutive patients who received nutritional support and that were hospitalized in the Hospital Río Ortega (Valladolid) since January 1999 to June 2001 has been studied. In this study only the direct costs were analyzed. RESULTS: The nutritional support was effective in the complete group with an improvement in the serum levels of albumin, prealbumin, and transferrin. In the analysis of direct costs generated by enteral nutrition the total median cost was of 598.4 +/- 761 euros/total treatment/patient, which represents a daily median cost of 36.3 +/- 8.8 euros/day/patient. In the analysis of costs by paragraphs, the expendable equipment constituted 36% of the total, representing the tubes 3%, the lines of nutrition 12%, the containers 21% and the nutritional preparations 64%. A cost analysis was also carried out in relation to the different groups of pathologies, and in this way the patients with hematological tumors and the patients with higher aereodigestive tract tumors showed some greater costs, due to their higher median hospital stay. The patients who received nutrition through a gastrostomy probe showed also higher costs, in addition due to a greater hospital stay. CONCLUSIONS: The costs of the nutritional support were superior in the group of patients with hematological tumors and with higher aereodigestive tract, due to their greatest hospital stay. A greater cost in the patients whose access route was the gastrostomy was also observed.

[Usefulness of miglitol in patients with diabetes mellitus type 2 and insufficient control of the blood glucose]. / Utilidad del miglitol en pacientes con diabetes mellitus tipo 2 y mal control glucémico.

OBJECTIVE: Miglitol belongs to the group of the inhibitors of the alpha-glucosidases and in several studies has demonstrated its usefulness in the improvement of the glycemic control in the different types of diabetic patients. The goal of our study was to analyze the usefulness of miglitol in the blood glucose and lipid control in a group of patients with diabetes type 2 treated with sulfonylureas and insulin, with insufficient glycemic control. PATIENTS AND METHODS: A group of 33 patients with diabetes mellitus type 2 treated with sulfonylureas and insulin and with insufficient glycemic control (HbA1c>7.5%) was studied. All patients were treated with miglitol during 3 months with progressive doses: the first week 50 mg twice a day, subsequently and during one month 50 mg three times a day. At the beginning of the study and up to three months the following variables were measured; weight, height, BMI (body mass index), systolic and diastolic blood pressure, HbA1c, number of episodes of peripheral hypoglycemia, basal glucose, albuminuria, total cholesterol, LDL-cholesterol, HDL-cholesterol and triglycerides, as well as transaminases (GOT, GPT, gamma GT and bilirubin). RESULTS: The median age was 64.1 +/- 12.5 years, and the median length of diabetes mellitus was 9.1 +/- 7 years. The median value of BMI was 27.7 +/- 6.9 kg/cm2. The blood glucose and HbA1c values decreased 4.8% and 5.8%, respectively. A decrease in the number of hypoglycemia episodes (39.4% previous quarter versus 3% quarter wih miglitol) was observed. Also decreased the dose of sulfonylureas needed by the patients (86.2 +/- 24.3 mg/day versus 64.6 +/- 21.9 mg/day; p<0.05) (25%). Total cholesterol, HDL-cholesterol, and LDL-cholesterol levels were not modified, but indeed a reduction of the levels of triglycerides (145.2 +/- 111 mg/dl versus 133.1 +/- 79 mg/dl; p<0.05) (8.3%) was detected. Fifteen percent of patients showed side effects (digestive discomfort) that disappeared two or three weeks after beginning the treatment. CONCLUSIONS: Miglitol is a useful drug in order to improve the glycemic control in diabetic type 2 patients treated previously with other drugs and with insufficient control of the blood glucose. Its side effects are limited and transitory.

Iron overload and genotype 3 are associated with liver steatosis in chronic hepatitis C.

OBJECTIVE: To determine epidemiological, biochemical, virological, and histological factors associated with liver steatosis in chronic hepatitis C. SUBJECTS: The medical histories of 53 patients biopsied for chronic hepatitis C diagnosis between June 2000 and December 2002 were retrospectively studied. Epidemiological, biochemical, and virological data were collected. Patients with hepatitis B virus or human immunodeficiency virus coinfection were excluded. Liver biopsy specimens were reviewed and scored by one pathologist. Weight and height were measured at liver biopsy time. The statistic association between qualitative and quantitative variables and the presence of liver steatosis was studied. RESULTS: Steatosis was identified in 52% of biopsies. There was no statistic association with age, sex, method of transmission, duration of infection, alcohol consumption, other diseases, body mass index, glucose, triglycerides, cholesterol, AST, ALT, GGT, alkaline phosphatase, bilirubin, or viral load. Liver steatosis was associated with serum iron, transferrin saturation, and ferritin. Genotype 3 was also associated with steatosis. Piecemeal necrosis, hepatocellular injury, Kupffer cell hyperplasia, liver iron, and portal fibrosis were also associated with steatosis. A multivariate analysis showed that genotype 3, Kupffer cell hyperplasia, and liver iron were associated with the presence of steatosis. CONCLUSIONS: Liver steatosis in chronic hepatitis C associates with genotype 3, Kupffer cell hyperplasia, and iron overload. Hepatic steatosis also associates with greater inflammation and fibrosis, and must be considered to contribute to disease progression.